Experts recommend drugs, surgery for teenage obesity in new guidelines
For the first time ever, experts from The American Academy of Pediatrics recommends proactive medical intervention against childhood obesity. The organization’s new guidelines will no longer ask doctors to simply observe or delay treatment in children with obesity, defined as a body mass index above 30. Instead, they now emphasize a range of options, such as dietary and lifestyle counseling for younger children, as well as medication and/or or operations for children 12 and older.
Previous standards for treating childhood obesity called for “watchful waiting,” hoping that a child’s BMI (a measure of weight and height) would naturally fall over time as the child grows. In 2007, the AAPs previous recommendations he promoted a step-based approach, where doctors can slowly escalate from observation to treatment. But these new recommendations—released Monday—there are the first clinical practice guidelines that put the treatment of obesity in the foreground.
“There is no evidence that ‘watchful waiting’ or delayed treatment is appropriate for obese children,” said Sandra Hassink, one of the guideline’s authors and vice chair of the AAP’s Clinical Practice Guidelines Subcommittee on Obesity, in statement issued by the organization. “The goal is to help patients make lifestyle, behavioral or environmental changes in a way that is sustainable and involves families in decision-making every step of the way.”
The lengthy guidelines outline the multitude of treatments available, depending on the child’s age and other circumstances (children under 2 are not considered eligible for obesity treatment).
For younger children, these options may include intensive behavioral and lifestyle treatment, which may include regular counseling sessions with the child and family over a 3- up to a 12-month period. For children aged 12 and over, doctors are now advised to consider medication as a first option. And teenagers 13 and older can also be evaluated for bariatric surgery as a potential treatment.
In making his own recommendations, the AAP cites many studies that suggest the benefits of these treatments outweigh any potential risks they may carry. Patients who have undergone bariatric surgery appear to have a lower risk of developing obesity-related complications, such as type 2 diabetes and there is And longer life span compared to non-surgical patients matched for age and baseline BMI, for example. long-appointment health benefits have also been observed in teenage patients with bariatric disease.
A new class of drugs, called incretins, too changed a lot the landscape of obesity treatment in recent years. These drugs, combined with diet and exercise, have produced far greater weight loss on average than most other treatments and approach the typical results seen with bariatric surgery.
Last month, the Food and Drug Administration expanded approval of Novo Nordisk’s Wegovy, the first drug of this new generation, for children over 12 years of age, following data from clinical trials showing that teenagers saw similar improvements in BMI as adults. The shortages that have plagued Wegovy’s rollout since its approval in June 2021 may also finally end, with the company recently announcing that his supply should now be stable. However, without insurance, which is often limited, the drug can still cost more than $1,000 a month.
The AAP guidelines come at a time of rising obesity rates in the US, including among childrenit just sped up, probably partly due to the covid-19 pandemic. The new recommendations do not specifically cover how best to prevent childhood obesity, although the organization has promised to publish separate recommendations for this in the near future.
“The medical costs of obesity to children, families and our society as a whole are well documented and require urgent action,” lead author Sarah Hampl said in a statement. “This is a complex issue, but there are a number of ways we can take steps to intervene now and help children and teenagers build the foundation for a long, healthy life.”